Date:  

Name:               

Spouse's Name:  

Street Address:  

City, State, Zip:  

Home Phone:        e-mail: 

Region(if known) Chapter

Check one of the following.  Dues include member and spouse

One Year United States Membership ($37.00)

One Year Foreign Membership ($ 65.00)

Introductory 1/2 year membership ($18.50, for new members registering between July 1 and October 1 of this calendar year)

 

Antique vehicles owned (Optional):  (Use ENTER after each vehicle)

Junior member names, 18 years old and younger ($5.00 dues per Junior)

Send this form, along with your check for dues payable to VMCCA to:

 VMCCA

7501 Manchester Ave.

Kansas City, MO 64138

We also can accept payment by credit card

MasterCard or Visa #   Exp. Date: 

Last three digits of special security code on your card's signature panel: